Woolfson R G, Jennings K, Whalen G F
Department of Surgery, University of Connecticut School of Medicine, Farmington, USA.
Arch Surg. 1997 Oct;132(10):1093-7. doi: 10.1001/archsurg.1997.01430340047006.
To determine the value of operation in patients with bowel obstruction caused by recurrent abdominal cancer.
Retrospective case review.
The University of Connecticut Health Center, Farmington.
Ninety-eight patients admitted with a diagnosis of bowel obstruction and malignant neoplasm between November 1, 1987, and June 30, 1995.
Data for 75 patients who developed a bowel obstruction within 5 years of a malignant diagnosis were analyzed. Forty-six patients (61%) were treated operatively and 29 (39%) were treated nonoperatively. The operative group included 32 patients (70%) whose obstruction was caused by carcinomatosis; 6 (19%) of these 32 patients had had at least 1 episode of previous obstruction requiring hospitalization. They had a 22% in-hospital mortality, stayed an average of 21 days in the hospital, and survived 7 +/- 6 months (mean +/- SD) after discharge; 5 (16%) had at least 1 episode of postoperative obstruction that required hospitalization. After discharge from the hospital, 53% had an excellent or good quality of life (assessed retrospectively). Of the 29 patients in the nonoperative group, 16 (55%) had carcinomatosis. These 16 patients had a 38% in-hospital mortality (6 of 16), stayed an average of 10 days in the hospital, and survived a mean of 13 +/- 9 months; 3 (19%) had at least 1 episode of recurrent obstruction requiring hospitalization. After discharge from the hospital, 6 (37%) had an excellent or good quality of life.
The value of operative intervention for bowel obstruction in patients with cancer is derived from the possibility of a benign cause, not alleviation of the consequences of carcinomatosis.
确定手术治疗复发性腹部肿瘤所致肠梗阻患者的价值。
回顾性病例分析。
康涅狄格大学健康中心，法明顿。
1987年11月1日至1995年6月30日期间收治的98例诊断为肠梗阻和恶性肿瘤的患者。
分析了75例在恶性肿瘤诊断后5年内发生肠梗阻的患者的数据。46例（61%）接受了手术治疗，29例（39%）接受了非手术治疗。手术组包括32例（70%）梗阻由癌性腹膜炎引起的患者；这32例患者中有6例（19%）曾至少有1次因肠梗阻住院治疗。他们的住院死亡率为22%，平均住院21天，出院后存活7±6个月（均值±标准差）；5例（16%）至少有1次术后肠梗阻需住院治疗。出院后，53%的患者生活质量为优或良（回顾性评估）。非手术组的29例患者中，16例（55%）有癌性腹膜炎。这16例患者的住院死亡率为38%（16例中有6例），平均住院10天，平均存活13±9个月；3例（19%）至少有1次复发性肠梗阻需住院治疗。出院后，6例（37%）患者生活质量为优或良。
手术干预癌症患者肠梗阻的价值源于存在良性病因的可能性，而非缓解癌性腹膜炎的后果。
